Suicide calls and compassion fatigue: Life as crisis line responders

Ianna Gayle S. Agus, ABS-CBN News

Posted at Dec 02 2022 12:58 PM | Updated as of Dec 02 2022 01:06 PM

Editor's note: This article has mentions of suicide, self-harm

Bernadette Logan spends a typical day at work answering calls from people who are on the brink of death—not because of any accident or physical illness but because of war inside their heads.
Logan had answered a lot of suicide calls in the two years being a crisis line responder in In Touch, a non-profit organization that offers mental health services, where she carried the responsibility of saving them—one call at a time. 
Like all other jobs, being a crisis line responder comes with its own challenges—even more so that they serve as a sponge for emotional and often devastating calls.
“Dumating yung point na parang ayoko na mag take ng shift kasi parang pagod ka eh, pagod ka na tapos parang ikaw rin tatanungin mo [sarili mo] kung ano pa maitutulong mo kasi parang binigay mo na lahat, eh,” she said.
Julian Montano, a psychologist and clinical director in In-Touch, called this “compassion fatigue,” where responders and other people who cater to mental health concerns experience burnout especially when everything “piles up.”
So for people like Logan, setting boundaries between life and work is a conscious decision they do every day, setting self-care habits or what they call “pagpag” as their number one priority.
“I put into mind na pag napasa ko na yung report, tapos na. Wala na akong gagawin na about work. Tapos na yun. So mag papagpag ako—manonood ako Netflix, pupunta sa mall pag may time pa at di pa ako inaantok, at kakain ng masarap. ‘Yun yung aking pagpag routine,” Logan said.
Crisis line responders are also discouraged from taking calls when they are not in the right headspace to ensure not just their callers’ safety but also their well-being, said Jake Flores, former In-Touch crisis line responder for six years and now Senior Manager for Corporate and Community Programs.
“’Di ka makakabigay ng tulong sa iba kung ikaw mismo ‘di ka okay or nangangailangan ka ng tulong. So you are doing yourself a service kung magpapahinga ka din muna bago ka tumulong sa iba,” Flores said.
“Dapat alam mo kung saan naghahanggang ang pakikipag-usap, ang problema ng ating mga callers, at wag mo sanang dadalhin ‘yun sa personal life mo. So after your shift or after the call, important na meron kang self-care at babalik ka sa normal na buhay mo,” he added.
Increase in calls, worsening concerns
In In-Touch alone, the 3,000 annual calls pre-pandemic went up by 50% when Covid-19 started, hitting up to 6,000 calls or more.
This upward trend has also been observed at the National Center for Mental Health (NCMH) at the onset of the pandemic, with calls averaging at 2,000 per month from the 200 to 300 monthly calls pre-pandemic. 
Aside from this sharp increase in the number of calls, the concerns of callers became worse, too.
According to the NCMH crisis hotline program coordinator Joseph Bonifacio, callers during the pandemic became more “high risk” which means that callers are in imminent danger and have the means and intention to harm themselves.
“[Sila 'yung] may suicidal thoughts, may plan na talaga at gagawin na talaga niya. Ico-continue na niya talaga,” Bonifacio explained.
Other callers are classified as “low risk,” or those who have suicidal thoughts but have no intention to do it, and “moderate risk” or those who have plans to harm themselves but are not in imminent danger during the call.
Montano affirmed this observation, saying mental health concerns progressed from anxiety to suicide ideations during the pandemic.
“Una, from anxiety, kasi syempre mga tao medyo kinabahan. After a few months, naging depression kasi napagod na rin yung mga tao. After a few months, lumabas yung mga trauma kasi we were also in grief and loss kasi marami na ring namamatay. And then dumating yung suicide,” Montano said.
According to the Philippine Statistics Authority, intentional self-harm is the 25th leading cause of death in the Philippines in 2020, or a total of 4.42 thousand deaths compared to 2.81 thousand in 2019 where it ranked 31st. 
Hard calls, fulfilling job
Recalling her hardest suicide call that lasted for more than an hour, Logan said the job was undeniably difficult but knowing that she saved someone’s life erased all the burden she felt.
“It was very challenging pero ang good thing about that is, the caller called us again the following day saying na okay na siya tapos nag avail siya ng counselling, ” Logan said. 
“Yun yung walang kapantay dun, eh, na you’re able to save and preserve a life… Iba yung nabibigay na fulfillment nun, na parang, ano yung ginawa ko to deserve this kind of fulfillment?” she added.
For Flores, suicide calls—where some could get frantic—are also the hardest call to take.
“Pinaka challenging [call] talaga ay syempre, ang mga suicide calls. Yung mga tao na tumatawag na satin na talagang they sound decided to actually commit [suicide] already and to do self harm,” he said. 
But even the grimmest and most debilitating call can still signify hope, Flores said.
“Ang thread of hope namin sa mga ganitong tawag is tumawag siya. Diba, kung decided ka na to end your life, you are still calling for help. There’s still something there, there’s still that little space of hope na meron kang kinakailangan, na merong maibibigay sa'yo na tulong,” he said.
“So 'yung little wiggle room na 'yun… talagang we will stay there [and] hopefully we will enlarge that to create a safe space para sa callers natin,” he added.
Flores admitted that the job could get really tiring, considering the deluge of calls—from mild concerns to alarming ones—but said that a single “thank you” from callers could lift all the stress.
“Sa lahat naman siguro ng trabaho may aspect na mentally taxing, na mentally demanding. Siguro ang pinaka naiiba lang sa work na to is you deal with emotions, feelings ng mga people. Nakakapagod din syempre makinig for a long period of time and yet ang pambawi doon is… sa dulo ng tawag, merong magpapasalamat sayo,” he said.
But Flores clarified that crisis line responders do not actually give advice, saying that they only lend an ear, provide callers a safe space, and help them make sense of their thoughts. 
“We have to just be there for the caller, provide a safe space for them. Hindi tayo pwede mag desisyon para sa kanila. Hindi natin pwede sabihin, nako, ito gawin mo sa problema mo. So we just hve to be there, listen, ask the right questions,” he said.

Overwhelmed workforce

Aside from accessibility and people’s lack of awareness about crisis hotlines, Bonifacio said funding and the insufficient number of responders continue to be a problem.

“Kailangan talaga ng funding para masustain yung program and another [problem] is insufficient number of responders… there is not enough responders to cater to all Filipinos nationwide,” he said.

As of writing, the NCMH only has more than 20 responders and they cater to 2,000 calls per month.

Because of the restriction on the number of people allowed in the office and the sheer lack of responders, they work for 12 hours per shift.

 Normalize mental health issues
Contrary to common belief, Flores said there are studies that show that openly talking about suicide and mental health issues actually lessens suicide risks.
“Research actually shows na if you address it, and if you open up and if you talk about it, talking about suicidal ideation, actively helps lower the likelihood na itutuloy,” he said
Montano echoed this, saying that the stigma that surrounds mental health would not end if conversations about mental health are not normalized.
“The more you show it, the more it becomes normal [and] common and so, acceptable… It is best to talk about it. To bring it out. To normalize it. [W]e empower everyone by talking about it,” he said. 

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Reach out, speak up
Bonifacio urged people to not hesitate asking for help, saying those who are going through hard times should “continue on with living” because there are people—like crisis line responders—who are willing to listen to them.
“Hindi ka dapat mahiya. Don’t feel ashamed na mag seek ng help. There are people who are willing to listen and your story matters,” he said.

Note: Current crisis line responders cannot be interviewed to protect the anonymity and confidentiality of crisis hotline calls. With this, ABS-CBN News interviewed former crisis line responders instead.
In-Touch crisis line numbers
+63 2 8893 7603
+63 919 056 0709
+63 917 800 1123
+63 922 893 8944
NCMH crisis line numbers
1800-1888-1553 Unlimited calls nationwide with a one-time fee of Php7.50
SMART / SUN / TNT: 0908-639-2672
GLOBE / TM: 0966-351-4518 ; 0917-899-8727


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